Archives of Bone and Joint Surgery-ABJS最新文献

{"title":"Subtrochanteric Fractures of The Femur: May a Short Nail Be a Reliable Option?","authors":"María Berta Alonso Polo, Claudio Peix, Paula Velasco, Sergio Marcos, Francisco Borja Sobrón, José Cordero Ampuero","doi":"10.22038/ABJS.2024.67182.3194","DOIUrl":"10.22038/ABJS.2024.67182.3194","url":null,"abstract":"<p><strong>Objectives: </strong>Treatment of subtrochanteric fractures of the proximal femur may be challenging due to their anatomical and biomechanical features. Intramedullary nails are the most frequently used devices, although there is no consensus concerning their optimal length. The aim of this study is to compare the functional and radiological outcomes of the fragility subtrochanteric fractures treated with short versus long cephalomedullary nails.</p><p><strong>Methods: </strong>A retrospective cohort study was performed including all over-65-year-old patients that underwent surgery with a cephalomedullary nail between January 2013 to December 2020 due to a subtrochanteric fracture. The primary outcome was the presence of mechanical complications (cut out, cut in, varus consolidation, nonunion and nail breakage). Accuracy of the reduction, distance from the fracture line to most proximal distal screw, operative time and Palmer Mobility score were also analyzed.</p><p><strong>Results: </strong>Ninety-five patients were included. There were not significant differences in complication rate, Parker mobility score nor quality of reduction between both cohorts. Patients with a good radiological reduction presented no complications, those with an acceptable reduction presented a complication rate of 35.5% and it raised to 53.3% in poorly reduced ones (P=0.002). The complication rate was higher in the <5cm distance group (58.33%) than in the >5cm distance group (22.64%) (P=0.014).</p><p><strong>Conclusion: </strong>Anatomical reduction may be the key factor in the management of subtrochanteric fractures, in order to avoid complications. The chosen device working length should also be taken into account to treat these challenging injuries.</p>","PeriodicalId":46704,"journal":{"name":"Archives of Bone and Joint Surgery-ABJS","volume":"12 11","pages":"798-804"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11756541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative Real-Time Polymerase Chain Reaction May Serve as a Useful Adjunct to Conventional Culture in The Detection of Cutibacterium acnes in the Glenohumeral Joint: A Study of 100 Consecutive Patients.","authors":"Matthew Como, Rajiv P Reddy, Margaret L Hankins, Gillian E Kane, Dongzhu Ma, Peter G Alexander, Kenneth L Urish, Amin Karimi, Albert Lin","doi":"10.22038/ABJS.2023.70190.3295","DOIUrl":"10.22038/ABJS.2023.70190.3295","url":null,"abstract":"<p><strong>Objectives: </strong>Synovial fluid or tissue culture is the current gold standard for diagnosis of infection, but Cutibacterium acnes (C. acnes) is a frequent cause of shoulder PJI and is a notoriously fastidious organism. The purpose of this study was to compare quantitative real-time polymerase chain reaction (qRT-PCR) to standard culture as a more rapid, sensitive means of identifying C. acnes from the glenohumeral joint. We hypothesized that qRT-PCR would be more effective than standard culture at identifying C. acnes and would have greater sensitivity and specificity for detecting infection.</p><p><strong>Methods: </strong>This was a prospective observational study with 100 consecutive patients undergoing arthroscopic or open shoulder surgery with known positive and negative controls. Intraoperatively, synovial fluid and tissue was obtained for C. acnes qRT-PCR and results were blinded to the gold standard microbiology cultures.</p><p><strong>Results: </strong>Clinical review demonstrated 3 patients (3%) with positive cultures, none of which were positive for C. acnes. Of the samples tested by the C. acnes qRT-PCR standard curve, 12.2% of tissue samples and 4.5% of fluid samples were positive. Culture sensitivity was 60.0%, specificity was 100.0%, PPV was 100.0%, and NPV was 97.9%. C. acnes qRT-PCR standard curve sensitivity, specificity, PPV, and NPV was 60.0%, 90.3%, 25.0%, and 97.7% respectively for tissue specimens and 0%, 95.2%, 0%, and 95.2% respectively, for fluid specimens. For combination of culture and tissue qRT-PCR, the sensitivity, specificity, PPV and NPV was 100%, 90.3%, 35.7%, and 100%, respectively.</p><p><strong>Conclusion: </strong>We report that qRT-PCR for C. acnes identified the organism more frequently than conventional culture. While these findings demonstrate the potential utility of qRT-PCR, the likelihood of false positive results of qRT-PCR should be considered. Thus, qRT-PCR may be useful as an adjuvant to current gold standard workup of synovial fluid or tissue culture for the diagnosis of infection.</p>","PeriodicalId":46704,"journal":{"name":"Archives of Bone and Joint Surgery-ABJS","volume":"12 2","pages":"102-107"},"PeriodicalIF":1.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10898805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139991483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to Avoid Common Complications in Hamstrings Harvest for Anterior Cruciate Ligament Reconstruction: A Practical Guide - Letter to Editor.","authors":"Yi-Yen Tsai, Zhi-Hong Zheng","doi":"10.22038/ABJS.2023.75674.3502","DOIUrl":"10.22038/ABJS.2023.75674.3502","url":null,"abstract":"","PeriodicalId":46704,"journal":{"name":"Archives of Bone and Joint Surgery-ABJS","volume":"12 2","pages":"148"},"PeriodicalIF":1.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10898797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139992287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative Analysis of Scapular Winging Using Moire Topography.","authors":"Nathan S Lanham, Rifat Ahmed, H Rachel Park, Bryanna Geiger, Helen Ugulava, Sidney J Perkins, Walker J Magrath, Stephanie L Rager, Katherine E Reuther, Charles M Jobin","doi":"10.22038/ABJS.2024.77150.3565","DOIUrl":"10.22038/ABJS.2024.77150.3565","url":null,"abstract":"<p><strong>Objectives: </strong>Moire Topography (MT) is a non-invasive technique that uses patterned light projection and has been used to qualitatively characterize scapular winging. The purpose of the present study was to quantitatively characterize scapular winging using a novel method of MT.</p><p><strong>Methods: </strong>A total of 20 shoulders in ten healthy subjects were analyzed. The mean age for subjects was 27.9 ± 1.0 years and mean BMI was 22.8 ± 2.8. Two scenarios were used to simulate scapular winging: Group 1) the hand-behind-back (HBB) position and Group 2) weighted scaption after a muscle fatigue protocol. A calibration object was used to validate the MT method. This was followed by a use of a control object with known dimensions (OKD) to evaluate subjects. The measured height (z) of the OKD with MT, as determined by the known dimensions of the OKD, was then compared to the scapula winging in Groups 1 and 2. Scapular winging was characterized by measuring the height or prominence (z) of the scapula.</p><p><strong>Results: </strong>There were significant differences between the baseline scapular measurements and scapular winging measurements in both Group 1, 4.0 cm ± 1.3 (P=0.0004), and Group 2, 3.7 ± 1.6 (P=0.0178). Scapular winging was most prominent with the hand in the highest position on the back in Group 1 and at lower degrees of scaption (<60 degrees) in Group 2.</p><p><strong>Conclusion: </strong>Quantitative characterization of scapular winging was achieved using a novel method using MT. Scapular winging was found at lower degrees of shoulder elevation. Future applications of this technique should focus on characterizing scapular winging in multiple planes in real-time and in patients with known shoulder pathology.</p>","PeriodicalId":46704,"journal":{"name":"Archives of Bone and Joint Surgery-ABJS","volume":"12 10","pages":"713-720"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11519426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142550101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MicroRNAs in Aseptic Loosening of Prosthesis: Pathophysiology and Potential Therapeutic Approaches.","authors":"Reza Minaei Noshahr, Farzad Amouzadeh Omrani, Atefeh Yadollahzadeh Chari, Mohammad Salehpour Roudsari, Firoozeh Madadi, Saman Shakeri Jousheghan, Alireza Manafi-Rasi","doi":"10.22038/ABJS.2024.70918.3319","DOIUrl":"10.22038/ABJS.2024.70918.3319","url":null,"abstract":"<p><strong>Objectives: </strong>Aseptic loosening (AL) is one of the leading causes of total joint arthroplasty (TJA) revision. Discovering the roles of microRNAs (miRNA/miR) in ontogenesis and osteolysis has attracted more attention to diagnosing and treating bone disorders. This review aimed to summarize miRNA biogenesis and describe the involvement of miRNAs in AL of implants.</p><p><strong>Methods: </strong>A detailed search was carried out on scientific search engines, including Google Scholar, Web of Science, and PubMed, to find appropriate papers related to subjects. The search process was performed using the following keywords: \"Implant\", \"miRNAs\", \"Wear particles\", \"Osteoclasts\", \"Total joint replacement\", and \"Osteolytic diseases\".</p><p><strong>Results: </strong>miRNAs play an essential role in the regulation of gene expression. AL is associated with several pathologic properties, including wear particle-induced persistent inflammatory response, unbalanced osteoclastogenesis, abnormal osteoblast differentiation, and maturation. Recent researches have revealed that these pathological events are closely associated with miRNA deregulation, confirming the relationship between miRNA and AL of prostheses.</p><p><strong>Conclusion: </strong>With the results of the new approaches to target miRNA, the essential role of miRNA is further defined. Understanding the mechanisms of miRNAs and related signaling pathways in the pathophysiology of AL will help scientists illuminate novel therapeutic strategies and specific targeted drugs.</p>","PeriodicalId":46704,"journal":{"name":"Archives of Bone and Joint Surgery-ABJS","volume":"12 9","pages":"612-621"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11531769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Preoperative Bevacizumab Associated with Increased Complications After Urgent Hip Fracture Surgery? A Retrospective Review.","authors":"Soheil Sabzevari, Bernadelle Boateng, Jessica A Lavery, Meredith K Bartelstein","doi":"10.22038/ABJS.2024.75222.3478","DOIUrl":"10.22038/ABJS.2024.75222.3478","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate whether patients with impending or completed fracture of the proximal femur who were treated with bevacizumab in the six weeks prior to surgery are at higher risk of surgical complications than patients given bevacizumab outside of the six-week period.</p><p><strong>Methods: </strong>We retrospectively reviewed cases of hip fracture treated between 1995 and 2020 at our institution. Patients were included if they were age 18 years or older, underwent hip surgery for impending or completed fracture, and received bevacizumab preoperatively but not postoperatively. Charts were reviewed for demographic, surgical, and postoperative details. A Cox model was applied to assess whether the timing of preoperative bevacizumab administration (≤6 weeks vs. >6 weeks) was associated with the risk of a postoperative complication.</p><p><strong>Results: </strong>Two of the 23 patients who received bevacizumab ≤6 weeks before surgery experienced complications (deep vein thrombosis [n=1] and intraoperative fracture related to progression of disease [n=1]). Of the 53 patients who received bevacizumab more than six weeks preoperatively, five experienced complications (wound drainage [n=2] and deep vein thrombosis [n=3]). In the Cox model, timing of bevacizumab was not associated with postoperative complications (univariable hazard ratio, 0.92; 95% confidence interval, 0.18-4.73).</p><p><strong>Conclusion: </strong>In this cohort of patients who underwent surgery for hip fractures, we did not observe an increased risk of postoperative complications among those who received bevacizumab within six weeks of surgery relative to those who received bevacizumab more than six weeks before surgery. The retrospective nature of the study and small sample size are limiting factors in this study.</p>","PeriodicalId":46704,"journal":{"name":"Archives of Bone and Joint Surgery-ABJS","volume":"12 9","pages":"645-651"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11531764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Medial Longitudinal Arch Height of the Foot on Static and Dynamic Balance in 7-10-Year-Old Boy Gymnasts.","authors":"Mohammad Seyedahmadi, Karim Khalaghi, Sahar Hazrati, Fahimeh Keavanloo","doi":"10.22038/ABJS.2024.79775.3645","DOIUrl":"10.22038/ABJS.2024.79775.3645","url":null,"abstract":"<p><strong>Objectives: </strong>This research aims to investigate the relationship between the height of the internal longitudinal arch of the foot and the static and dynamic balance of 7-10-year-old boy gymnasts.</p><p><strong>Methods: </strong>This study was descriptive-correlational, and its statistical population included male gymnast students aged 7 to 10 in the city of Gouchan. These gymnasts were screened for flat feet using the Brady test. Ninety gymnasts were purposefully selected based on the Brody test to assess the arch of the foot and were divided into three groups: pronation (n=30), supination (n=30), and normal (n=30). The Flamingo test assessed static balance, and the Y Balance test assessed dynamic balance. The Shapiro-Wilk test was used to check the normality of data distribution, and a one-way analysis of variance was employed to compare the results obtained among the groups. Data analysis was performed using SPSS software (version 21).</p><p><strong>Results: </strong>The results showed a significant difference between static and dynamic balance in male gymnasts with pronation, supination, and natural foot conditions (P=0.001 and P=0.013, respectively). The results demonstrated no significant difference in static balance between gymnastic boys with pronation and suspension (P=0.930); however, there was a significant difference in static balance between gymnastic boys with suspension and those with a natural state (P=0.0001) and between gymnastic boys with pronation and those with a natural state of the foot (P=0.001).</p><p><strong>Conclusion: </strong>Based on the results, gymnastic boys with different arch heights (pronated, supinated, natural) showed static and dynamic balance variations. Boys with pronated or supinated feet had poorer static and dynamic balance than those with natural arches. Based on these results, coaches and corrective movement specialists can help boy gymnasts with different arch heights to optimize their balance performance and reduce the risk of injury.</p>","PeriodicalId":46704,"journal":{"name":"Archives of Bone and Joint Surgery-ABJS","volume":"12 12","pages":"846-853"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Iatrogenic Medial Collateral Ligament Injury in Primary Total Knee Arthroplasty: A Systematic Review.","authors":"Shayan Amiri, Alireza Mirahmadi, Ava Parvandi, Pooya Hosseini-Monfared, Reza Minaei Noshahr, Seyyed Mehdi Hoseini, Seyed Morteza Kazemi","doi":"10.22038/ABJS.2023.73563.3406","DOIUrl":"https://doi.org/10.22038/ABJS.2023.73563.3406","url":null,"abstract":"<p><strong>Objectives: </strong>The medial collateral ligament (MCL) injury is one of the possible complications of primary total knee arthroplasty (TKA), which can lead to coronal-plane instability that requires surgical revision. Injured MCL can result in joint instability and polyethylene wear. Different strategies have been proposed for MCL reconstruction based on the location of the injury. However, there is a lack of clarity regarding the optimal method for handling an iatrogenic MCL injury throughout a TKA.</p><p><strong>Methods: </strong>A PRISMA flow diagram was used to guide the systematic literature review. An extensive search was conducted in PubMed, Embase, Scopus, Web of Science, and Google Scholar. Newcastle Ottawa scale checklist was used to assess the methodological quality of the articles.</p><p><strong>Results: </strong>A total of 19 qualitative studies, including non-cadaveric patients with MCL injury during TKA, were identified after analyzing the full text of the articles. All included studies were either retrospective, observational cohort or case series. A total of 486 patients were studied to gather information on the methods used to repair the MCL and their results. Most injuries arose in the tibial attachment, which surgeons mostly realized during the final stages of surgery. Used techniques can be categorized into three main groups: Primary repair, Repair with augmentation, and changing prosthesis characteristics.</p><p><strong>Conclusion: </strong>This systematic review demonstrated that the most popular management of iatrogenic MCL injury was using suture anchors, staples, screws and washers, and more constrained prostheses. The proper method should be decided considering the site of the MCL injury.</p>","PeriodicalId":46704,"journal":{"name":"Archives of Bone and Joint Surgery-ABJS","volume":"12 3","pages":"159-166"},"PeriodicalIF":1.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10989723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140870364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Return to Emergency Department and Readmission Following Primary Elective Total Shoulder Arthroplasty.","authors":"Cameron Smith, Robert Ades, Yungtai Lo, Savino Stallone, Suhirad Khokhar, Konrad I Gruson","doi":"10.22038/ABJS.2024.77508.3581","DOIUrl":"10.22038/ABJS.2024.77508.3581","url":null,"abstract":"<p><strong>Objectives: </strong>Returns to the Emergency Department (ED) and unplanned readmissions within 90 days of shoulder arthroplasty represent a significant financial burden to healthcare systems. Identifying the reasons and risk factors could potentially reduce their prevalence.</p><p><strong>Methods: </strong>A retrospective review of primary anatomic (aTSA) and reverse shoulder arthroplasty (rTSA) cases from January 2016 through August 2023 was performed. Demographic patient and surgical data, including age, diagnosis of anxiety or depression, body mass index (BMI), smoking status, age-adjusted Charlson Comorbidity Index (ACCI), modified 5-item fragility index (mFI-5), and hospital length of stay (LOS) was collected. Patient visits to the ED within 12 months prior to surgery were recorded. Predictors for return to the ED within 90 days postoperatively and any readmissions were determined.</p><p><strong>Results: </strong>There were 338 cases (167 aTSA and 171 rTSA), of which 225 (67%) were women. Patients with anxiety (OR=2.44, 95% CI 1.11-5.33; P=0.026), surgical postoperative complications (OR=3.22, 95% CI 1.36-7.58; P=0.008), ED visit within 3 months prior to surgery (OR=3.80, 95% CI 1.71-8.45; P=0.001), ED visit 3 to 6 months prior to surgery (OR=2.60, 95% CI 1.12-6.05; P=0.027), and ED visit 6 to 12 months prior to surgery (OR=2.12, 95% CI 1.02-4.41; P=0.045) were more likely to have ED visit within 90 days postoperatively. Patients with prior ipsilateral shoulder surgery (OR=3.32, 95% CI 1.21-9.09; P=0.02), surgical postoperative complications (OR=13.92, 95% CI 5.04-38.42; P<0.001), an ED visit within 3 to 6 months preoperatively (OR=8.47, 95% CI 2.84-25.27; P<0.001), and an mFI-5 ≥2 (OR=3.66, 95% CI 1.35-9.91; P=0.011) were more likely to be readmitted within 90 days.</p><p><strong>Conclusion: </strong>Patients who present to the ED within 12 months prior to shoulder arthroplasty, those with anxiety, those with surgical complications and those with higher fragility should be monitored closely during the early postoperative period to minimize returns to the ED and/or unplanned readmissions.</p>","PeriodicalId":46704,"journal":{"name":"Archives of Bone and Joint Surgery-ABJS","volume":"12 7","pages":"477-486"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11283301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"90-day Return to the Emergency Department Following Shoulder Arthroscopy: Prevalence, Risk Factors, and Reasons.","authors":"Cameron Smith, Emmanuel Mbamalu, Savino Stallone, Yungtai Lo, Konrad I Gruson","doi":"10.22038/ABJS.2024.78325.3606","DOIUrl":"10.22038/ABJS.2024.78325.3606","url":null,"abstract":"<p><strong>Objectives: </strong>Return to the Emergency Department (ED) within 90-days following arthroscopic shoulder surgery represents a potential source of increased healthcare expenditures. Understanding the risk factors could bring about interventions aimed at reducing its prevalence.</p><p><strong>Methods: </strong>A retrospective review of all shoulder arthroscopies undertaken at a single academic institution from February 2016 through November 2023 was performed. Patient demographics and surgical data, including age, diagnosis of mental health disorder, history of prior ipsi- and/or contralateral shoulder arthroscopy, body mass index (BMI), smoking status, age-adjusted Charlson Comorbidity Index (ACCI), operative time and nature of the surgical procedure was collected. Patient visits to the ED within 12 months prior to surgery were recorded. Regression analysis was utilized to determine the independent predictors for 90-day postoperative ED return.</p><p><strong>Results: </strong>There were 584 total cases included in this study, of which 303 (52%) were women. The median age of the cohort was 57 years (IQR 51,62). There were 60 (10.3%) patients who experienced at least one unplanned 90-day ED return visit. A diagnosis of mental health disorder (OR 2.67, 95% CI 1.50-4.75, P=0.001), an ED visit within 3 months of surgery (OR 2.63, 95% CI 1.28-5.40, P=0.009), an ED visit between 3-6 months of surgery (OR 2.79, 95% CI 1.41-5.54, P=0.003), and an ED visit between 6-12 months of surgery (OR 1.98, 95% CI 1.07-3.66, P=0.029) was significantly associated with a 90-day unplanned postoperative ED visit. Finally, having >3 preoperative ED visits was significantly associated with a 90-day postoperative ED visit (OR 9.41, 95% CI 3.68-24.06, P<0.001).</p><p><strong>Conclusion: </strong>Patients with a history of mental health disorder and those with a visit to the ED within 12 months prior to the planned shoulder arthroscopy should be counseled preoperatively regarding appropriate direct contact with the treating surgical team following discharge to minimize postoperative 90-day ED visits.</p>","PeriodicalId":46704,"journal":{"name":"Archives of Bone and Joint Surgery-ABJS","volume":"12 11","pages":"760-769"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11756542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}